Spondylitis

Spondyloarthropathy

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Spondyloarthropathy

  • Pathophysiology
  1. Spondyloarthropathies share HLA-B27 genetic predisposition
  • Findings
  • Common to every Spondyloarthropathy
  1. Inflammatory back pain
  2. Peripheral Arthritis
  3. Dactylitis
    1. Inflammation of entire digit
  4. Enthesitis
    1. Inflammation of tendon and ligament bony attachments
    2. Common areas of involvement
      1. Achilles tendon insertion (Calcaneus)
      2. Platar fascia insertion (Calcaneus)
      3. Patellar tendon insertion (tibial tubercle)
      4. Patella margin (superior and inferior)
      5. Metatarsal heads
      6. Spinal ligament insertion (Vertebral body)
  • Causes
  1. Ankylosing Spondylitis
  2. Reactive Arthritis (previously known as Reiter's Syndrome)
  3. Psoriatic Arthritis
  4. Inflammatory Bowel Disease with Spondyloarthropathy
  • Differential Diagnosis
  1. Rheumatoid Arthritis
  • Labs
  1. HLA-B27 positive
    1. Test Sensitivity 80% for Axial Spondyloarthropathy
  2. Rheumatoid Factor (RF) negative
  3. Erythrocyte Sedimentation Rate (ESR) elevated
  4. C-Reactive Protein (CRP) elevated
  5. Complete Blood Count (CBC)
  6. Anemia of Chronic Disease
  7. Synovial Fluid exam: WBCs > 2,000/ml
  • Imaging
  1. Pelvis XRay
    1. Sacroiliitis frequently accompanies Spondyloarthropathy
  • References
  1. Liu in Noble (2001) Primary Care, p. 1280-93
  2. Kataria (2004) Am Fam Physician 69:2853-60 [PubMed]
  3. Kim (2026) Am Fam Physician 114(3): 262-70 [PubMed]